A patient game of ping pong

This morning we saw a patient in her early sixties with complaints such as numbness of the extremities, headaches, chest pain, abdominal pain, epigastric pain and heart palpitations. She had been referred to our mental health unit from a health center in Awac, but her symptoms would have led any professional counselor to send her right back to a medical doctor. Through experience I had learned that when small rural health centers are not equipped to diagnose or treat more profound medical conditions, they often refer to larger hospitals such as Mulago, IHK or Case Clinic. In some unfortunate cases, doctors will conclude that the issue is psychiatric and send them to a mental health unit. This is how our patient ended up in our clinic with the hopes that we could somehow provide some answers to her problems. With the kaleidoscope of physical complaints, it felt almost absurd to dig for primary emotional complaints. At this point, the physical and emotional suffering had become so intertwined that the exercise seemed futile. Yet to get the patient referred back to medical, we had to conduct a battery of psychological assessments that demonstrated that the patient’s emotional suffering had indeed been activated by physical pain. Only after we had teased out the order and nature of her suffering, could we begin to recommend more sophisticated medical tests. Another patient arrived at our unit recovering from typhoid fever, but with a complete paralysis affliction on her left side. She had been treated and cleared by a medical team, and was now thought to be suffering from a psychogenic disorder. An assessment revealed that she had twice been attacked by the LRA. In one of these instances, she was severely beaten with an ax and left for dead on the side of the road. On our ward, with counseling and antidepressants, her condition however continued to steadily deteriorate. After two weeks of unsuccessfully treating her, it was hard to explain to her perplexed family that we thought it was best to refer her back to the medical ward.

In a workshop I attended last week, one of the presenters emphasized that as mental health professionals it is just as much of our duty to acknowledge when a client’s problem goes beyond the scope of our competence, as it is our duty to provide competent caring for the well-being of persons and peoples (Universal Declaration of Ethical Principles, 2008). Our sixty year old patient, and patient with paralysis showed me how difficult and messy competent caring can be in an environment where professional ethics are blurred or not existent at all.